Provider Demographics
NPI:1386079549
Name:DOUGLAS BOGART DMD, PA
Entity type:Organization
Organization Name:DOUGLAS BOGART DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGART
Authorized Official - Suffix:
Authorized Official - Credentials:DND
Authorized Official - Phone:352-344-9500
Mailing Address - Street 1:3581 E GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3210
Mailing Address - Country:US
Mailing Address - Phone:352-344-9500
Mailing Address - Fax:352-344-4398
Practice Address - Street 1:3581 E GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3210
Practice Address - Country:US
Practice Address - Phone:352-344-9500
Practice Address - Fax:352-344-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10453122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty